Transition of Care

We understand the importance of maintaining your health coverage without any interruption in your medical treatments or prescription medications. These steps will help you make a smooth transition switching over to the Optima Health Plan.

Incentive Program

In order to receive the incentives for the Optima Health Incentive Program, you must have one of the following chronic conditions, Asthma/COPD, Diabetes, or Hypertension, and submit the completed Transition of Care Assessment by June 26th 2019 for the July 1, 2019 enrollment year.


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What are your needs?

  • If have (Asthma/COPD, Diabetes, or Hypertension), what steps do I take to receive the financial incentive?

    • If you have one of the following chronic conditions (Asthma/COPD, Diabetes, or Hypertension), you may be eligible for a financial incentive. To find out complete the Transition of Care Assessment and a clinical services represenitive will reach out to you to discuss care.

      In order to receive the incentives for the Optima Health Incentive Program, you must have one of the following chronic conditions, Asthma/COPD, Diabetes, or Hypertension, and submit the completed Transition of Care Assessment by June 26th 2019 for the July 1, 2019 enrollment year.

  • If I have a chronic condition, how do I transition care?

    • If you have a chronic condition we encourage you to fill out the Transition of Care Assessment and a clinical services represenitive will reach out to you to discuss care.
  • I currently receive obstetrics care, medical treatment, or have a procedure scheduled

    • Call your doctor's or specialist's office and tell them you are changing my coverage to Optima Health.
    • Ask your doctor to send any clinical notes and authorizations to the Optima Health Clinical Care Services team.
  • I am scheduled for treatment that required an authorization

    • Optima Health will likely need to authorize this treatment. Please contact us.
  • I need refills for my prescriptions

    • Tell your prescribing doctor you will be switching your coverage to Optima Health.
    • If possible, get your prescription refilled in advance of your change in coverage.
  • My prescription requires prior-authorization*

    • For all members newly enrolling with Optima Health currently taking prescriptions requiring prior authorization, Optima Health will temporarily waive prior authorization requirements if your prescription is filled within:
  • Your Member ID card

    • Present your new member ID card to your doctor’s office and pharmacy so they can update your records

Exclusions:*

    1. Drugs prescribed outside of any age restriction, above a quantity limit, or above sale maximum daily dosage limits.
    2. All adult stimulants.
    3. Drugs excluded by the plan such as fertility or cosmetic drugs.